HIV and Care
of the Teeth and Gums
chapter
12
Many things in the world have changed since Where There Is No Dentist
was first published in 1983. One of the most profound changes has been
the spread of HIV and AIDS worldwide. Although millions of people are now
infected with HIV, the illness is still surrounded by fear and disinformation.
This chapter explains HIV and AIDS, what they mean for people who are
infected and for oral health workers, and how we can all work together to
prevent the spread of HIV.
For people with HIV, good
dental care can mean the
difference between living
and dying.
If a person with HIV has a
clean and healthy mouth,
he or she will be able to eat
well, be stronger, feel better,
and live longer.
Mary and David
Mary was 17 years old. She and her boyfriend David were expecting a baby.
David was Mary’s first boyfriend and he was very attentive and kind to
her. But David had not been well lately. His mouth had been very sore and
smelled bad all the time. Although he did not seem to have problems with
his teeth, it was hard to chew or swallow, and white spots appeared on
the roof of his mouth. Mary thought he should go to see the dental worker
at the health center. At first David refused. He said he did not want to talk
about it in a nervous voice. Finally David agreed to go if Mary would go too.
David said he wanted to see the dental worker by himself. So Mary sat in
the waiting room while David saw the dental worker.
175
176 Where There Is No Dentist 2012
After a while the dental worker came out and asked Mary to come into the
room. David was sitting on a chair looking worried. He tried to give Mary a
smile, but she could see his heart was not in it. The dental worker asked
David if she could tell Mary what she had found in David’s mouth. David
agreed, so the dental worker explained to Mary that David did not have any
problems with his teeth. He had infections in his mouth, gums, and throat.
This was why his mouth was sore and smelled bad all the time.
The dental worker said she would give David the dental care he needed.
But she also said she thought David’s problem might be caused by a much
more serious infection called HIV. That would explain why his body is weak
and he is unable to fight off the infection in his mouth. But to be sure, David
should get a blood test for HIV. And because HIV can be passed from one
person to another she encouraged Mary to get tested too. She explained
that the sooner you find out if you have HIV, the sooner you can start taking
medicines that help you and your baby live long and healthy lives.
I can treat the
problem in David’s
mouth, but I think he
has a serious infection.
It would be good for you
both to get tested so
that if you have HIV you
can protect youselves
and your baby.
The right information will help dental workers give good dental care to everyone.
This story shows why it is important for dental workers to know about
infections in the mouth that may be caused or made worse by HIV. With
correct and up-to-date information, dental workers can give the good dental
care everyone deserves, and can help prevent HIV from spreading to other
people or to themselves.
Health and dental workers must give people with HIV
the care they need. Make sure your health system provides the
resources (equipment, medicines) you need to give good care.
Where There Is No Dentist 2012 177
What ARe HIV And AIDS?
HIV (Human Immunodeficiency Virus) is a germ that causes AIDS (Acquired
Immune Deficiency Syndrome) by weakening the immune system, the part
of the body that fights off infection and disease.
A person is said to have AIDS when he or she starts to get many common
health problems more often than usual and stays sick longer. Some of these
problems are losing weight, sores that will not heal, a bad cough, sweating
at night, diarrhea, skin rashes, a fever, or feeling very tired all the time.
Without treatment the immune system of a person with AIDS gets weaker
and weaker and the person is less able to fight these health problems.
Most people with AIDS die from diseases their bodies are no longer strong
enough to fight.
Many people who are infected with HIV do not get sick for several years.
This means that a person can be infected with HIV and not know they have
it because they feel healthy. But HIV can be passed from one person to
another as soon as a person is infected. So, the only way to know if you are
infected is to take a blood test called an HIV test. This test can be done at
many clinics, hospitals, and other locations.
Medicines called anti-retrovirals, or ARVs,
can help people with HIV regain their
health or stay healthy for many years.
ARVs can also help prevent the spread
of HIV to a baby or to people who are
exposed accidentally. ARVs cannot cure
HIV, however. So these medicines must be
taken every day, for life.
Medicines for HIV are expensive, though
people affected by HIV have organized to
make them available in more countries and
at lower prices. Many governments and organizations provide ARVs for free
either through their own funding or with the support of international donors.
Talk to a health worker who has experience working with HIV to find out
where to go for treatment for HIV.
178 Where There Is No Dentist 2012
How is HIV Spread?
HIV lives in certain body fluids, such as blood, semen (sperm), and the fluids
in the vagina. The virus is spread when these fluids get into the body of
another person. This means that HIV can be spread by:
•
having unsafe or risky sex with someone who has the virus
(see page 198).
•
using injection needles or syringes that have not been sterilized
(see page 87).
•
using dirty instruments that cut the skin for injecting drugs, scarring,
piercing, circumcision, or dental care. Even if instruments have been
washed and look very clean, they can still have germs on them and can
spread HIV if they have not been sterilized (see page 87).
•
touching or receiving the blood of an infected person.
•
mother to child during pregnancy, birth, or breastfeeding.
•
splashing of blood into the eyes or mouth.
HIV does not live outside the
human body for more than a
few minutes. It cannot live on
its own in the air or in water.
This means you cannot give
or get HIV from everyday
contact, such as play, working
with someone, shaking hands,
sharing meals, or from spitting,
sneezing, coughing, sweating,
from tears, or from insect bites.
HIV is not spread by casual contact.
Where There Is No Dentist 2012 179
Who Gets HIV?
Millions of people all over the world are
infected with HIV. If the body is strong,
the HIV virus can grow quietly for several
years, slowly weakening the immune
system before it turns into AIDS. If the
body is weak, the diseases of AIDS may
develop more quickly.
Both rich and poor people can be infected with HIV, but the sickness is
worse for the poor. This is because poor people get more infections, which
weaken the body, because they do not have access to:
•
low-cost health care.
•
enough nutritious food.
•
clean, safe drinking water.
•
safe, uncrowded living conditions.
•
good sanitation.
Working to change these
conditions is an important
part of preventing the
spread of HIV and
improving the lives of
people who have HIV.
Most mouth infections
are not caused by
HIV, but all mouth
infections are serious
when a person is
infected with HIV.
How HIV Affects the Mouth
People with HIV are likely to have more problems inside the mouth than
people who do not have HIV. Because their bodies are weaker, any sores
and infections may spread more quickly than they do for healthier people.
So people with HIV may need more regular and careful help from dental
workers than other people in the community.
Most people with HIV will get at least one kind of infection or problem in
the mouth at some time during their illness. If this is not treated, it can be
painful, can affect how much food the person eats, and can cause more
serious health problems.
Infections in the mouth related to HIV affect the soft skin (tissue)—the
lips, the cheeks, the tongue, the lining of the roof of the mouth, under the
tongue, and the skin around the teeth (the gums). HIV does not directly
affect the teeth themselves. In the final stages of AIDS, the gums and the
jaw bone, which hold the teeth in place, may be destroyed. Also, HIV can
cause “dry mouth,” especially for people using ARVs (anti-retroviral drugs),
which makes it easier to get cavities (tooth decay).
180 Where There Is No Dentist 2012
How to Examine the Mouth
for Signs of HIV or AIDS
IMPORTANT: Y
ou cannot tell from looking at a person
if he or she has HIV.
Dental workers must always be careful to make sure they do not pass the
virus from one person to another during dental care.
Also, dental workers must protect themselves to make sure the virus
does not pass to them from someone they are treating. So always use
precautions against HIV infection with every person you see.
The best precautions are to always wear clean latex gloves or plastic bags
on the hands, a face mask, eye protection, and to use only clean, sterile
instruments. For information on how to clean and sterilize instruments, see
pages 86 to 91.
When you examine someone, always try to:
Wear glasses or goggles. Make sure you
can see through them clearly.
Wear a clean cloth or mask over
your nose and mouth. Try to change
the cloth several times a day. Before
wearing a cloth again, wash it in
clean soapy water, rinse, and hang it
in the sun to dry.
Wear clean gloves or plastic
bags on your hands.
If possible, dental workers should always be protected so they can prevent
HIV from passing to themselves, the people they are treating, their families,
and their sexual partners.
Where There Is No Dentist 2012 181
Always examine the lips, face,
and inside the mouth of someone
who wants advice about a dental
problem. Look for any swelling,
broken skin, sores, redness,
infection, or unusual color
changes. For information about the
most common problems caused
by HIV, see page 184.
Before you examine
someone, always
explain carefully
what you are going
to do.
Look carefully inside the cheeks and lips. Ask
the person to lift up her tongue so you can look
underneath it. Also, ask her to stick her tongue out.
Wrap a small piece of clean cloth around the tip of the
tongue and gently pull it forward so that you can see
the sides of the tongue, the back part of the mouth
and tongue, and as far down the throat as possible.
For more information on how to examine the mouth
and teeth, see Chapter 6, pages 73 to 83.
It is important to ask about the person’s general
health too. There may be other signs of HIV such as
fevers, night sweats, feeling very tired all the time,
weight loss, or diarrhea. Many people with HIV also
become ill with tuberculosis or cancers. If the person has
any of these problems, make sure he or she goes to see a
health worker or doctor who is experienced with HIV.
Feel along the jaw, underneath the jaw bone, and on
the upper neck to see if there are any lumps or pain.
182 Where There Is No Dentist 2012
Always tell the person what treatment you would like to give. After your
examination, explain what you found and what can be done to help or
prevent it from getting worse. Always ask the person for permission before
you do any treatment, just as you should for any person you see.
No one else should know if
someone has HIV, except for
those the person wants to know.
If you think it is important
to tell others, always ask for
permission first.
If you know or think
someone is infected with
HIV, do not tell anyone
else—even the person’s
family.
Respect the privacy of a person with HIV as you
would anyone who comes to you for dental care.
(See page 192, “Treat everyone with respect.”)
Where There Is No Dentist 2012 183
Dental care For a Person with HIV
In general, there is no need to change dental treatment because a person
is infected with HIV. This is especially true if the person has no signs of
HIV. If there is already an infection in the mouth, use a mouth wash before
treatment (see the “General Treatment” box on pages 184 and 185). This
will help prevent the infection from getting worse.
Anyone with HIV has the
right to get good dental
care and to be treated
with respect.
There are no special problems in doing simple fillings, or fitting false teeth
(dentures) for a person infected with HIV. But as the HIV infection advances
to AIDS, you will be able to give better dental care if you know about any
health problems the person may have. For example, if you need to take
out a tooth, you must be extra careful not to cause an infection (see page
pages 85 to 90). Remember, always use clean, sterilized instruments, and
when you give injections use only clean, sterilized needles and syringes, or
disposables, so you do not cause infections. If you have any concerns about
someone’s health, it may help to speak with a health worker.
Taking out a Tooth
To take out a tooth, follow all the guidelines in Chapter 11, page 163. In
addition, to prevent infection for someone with HIV, before you remove the
tooth, make sure the person’s mouth is as clean as possible. A mouth rinse
can help (see the “General Treatment” box on pages 184 and 185).
To prevent infection and to help with healing, gently scale or scrape away
the tartar (see Chapter 8) from all the teeth. Be careful to do as little damage
as possible to the gum and bone around the tooth you are taking out. An
infected tooth socket (the hole that is left after you take out the tooth) in a
person with HIV can be a serious problem. For problems after you take out a
tooth, see pages 171 to 173.
In the later stages of HIV infection when the person has AIDS, the blood
may not clot as quickly as normal. Be very gentle when you take out the
teeth. Take only one tooth out at a time, and wait until bleeding is controlled
before taking another one out.
184 Where There Is No Dentist 2012
Common Problems Caused by HIV
and How to Treat Them
There are many infections that occur in the mouth, such as a cold sore
or gum infection. Most of these infections are not caused by HIV and do
not usually cause serious problems. But all infections are serious when a
person has been infected with HIV because the virus makes the person’s
body weak and unable to fight off infection. Smoking or chewing tobacco
can also make problems in the mouth worse. Many infections for people
with HIV, including mouth infections, can be prevented by taking 480 mg of
cotrimoxazole 2 times a day with lots of water.
The main problems in the mouth
for persons with HIV are:
1. white or yellow patches
4. cold sores or blisters
2. open sores
5. dark-colored skin patches
3. gum infections
6. dry or painful mouth and throat
General treatment
Always remove false or plastic teeth (dentures) before using any of
these treatments.
Most of the problems in this chapter can be helped:
•
if the teeth are kept clean by brushing or
using a chewing stick every day, including
false or plastic teeth.
•
by rinsing the mouth several times a day
with a simple mouth wash made with salt
and clean water (see page 7).
1
2
3
Where There Is No Dentist 2012 185
•
by gently cleaning any infection or sores with a clean cloth that
has been moistened with salt water.
•
by gently wiping inside the mouth (teeth, gums, all the soft inside
skin) with a clean cloth.
Be careful if you use a chewing stick. Some wood is very hard and can
hurt and damage the gums. The soft wood from the neem tree (which
grows in many tropical countries) works well. You can also wrap clean
cloth around the pointed end of a small stick or tooth pick and use it to
carefully clean the teeth one at a time.
Other treatments that can help are:
•
chlorhexidine gluconate, 0.2%—a mouth wash that has no
alcohol in it. Hold some in the mouth for 1 minute, 2 times a
day. Make sure it covers the whole mouth inside, and then
spit it out. This mouth wash reacts badly with some kinds of
toothpaste. So wait 30 minutes between using this mouth wash
and brushing your teeth.
•
gentian violet, 0.5%—a purple-colored liquid that kills
germs. Paint it onto the parts of the mouth that are infected.
Sometimes it may be necessary to paint the whole inside of the
mouth. Try not to swallow any.
•
povidone iodine, 1%—a brown-colored liquid that kills germs.
Hold some in the mouth for 1 minute, 2 times a day. Make sure
it covers the whole mouth inside, and then spit it out (do not
swallow any). Do not use for more than 14 days. Do not use if
you are pregnant or breastfeeding.
•
hydrogen peroxide, 3% and clean water—(see page 8).
1
2
Mix hydrogen peroxide
evenly with water—that is
½ cup of hydrogen peroxide
with ½ cup of water.
3
Hold some
in the mouth
for about
2 minutes.
4
Spit it out and
repeat. Do this
every hour when
awake for 3 days.
186 Where There Is No Dentist 2012
1. White or yellow patches in the mouth
(thrush, oral candidiasis)
White, yellow,
or (sometimes)
red patches. The
patches in this
picture are behind
the bottom, front
teeth, but they
most often appear
on the roof of the
mouth and the top
of the tongue.
Thrush is the most common infection in the mouth seen in people with
HIV infection. Thrush can also be a problem for people who do not have
HIV. For more information about this, see page 105.
signs:
•
A burning or swelling feeling in the mouth, especially when eating
spicy foods. Because of pain, eating and swallowing become more
and more difficult.
•
The skin inside the mouth is usually covered with white, yellow, or
red patches. If you try to remove the white patches with a clean
cloth, they will come off, but sometimes leave a bleeding red
surface underneath. In some people they may not come off easily.
In a few people, there are no white patches. Instead, the skin of the
mouth is red and blotchy. It may look very rough.
•
Sometimes there are painful cracks
at the corners of the mouth that
will not heal and sometimes bleed.
Where There Is No Dentist 2012 187
Treatment :
Gently scrub the tongue and gums with a clean
cloth or soft toothbrush 3 or 4 times a day.
Then rinse the mouth with salt water and
spit it out (do not swallow). In addition,
if possible, use any ONE of these
remedies:
•
Put 2.5 ml (½ teaspoon) of nystatin
solution in the mouth and hold it there
2 minutes and then swallow it. Do this 5 times
a day for 14 days. OR,
•
Use either gentian violet or chlorhexidine gluconate mouthwash, as
described in the “General Treatment” box on page 184 and 185. OR,
•
Cut or break a 100 mg clotrimazole vaginal insert into 2 pieces. In the
morning, put 1 piece in the mouth and let it slowly melt there. Use the
second piece at night. The package may say: “Do not take by mouth.”
This means do not swallow it. It is safe to let it melt in the mouth,
making sure it covers the whole inside of the mouth, and then spit it
out. Do this 2 times a day for 7 days (14 days if the infection is very
bad). OR,
•
Depending on how bad your problem is, suck one or two 100,000 Unit
nystatin lozenges, 4 or 5 times a day for 10 to 14 days.
If thrush is very bad, or if it moves into your throat and makes it hard to
swallow, you may try one of these stronger medicines instead of the
remedies above. (But do not take either of these medicines if you are
pregnant or breastfeeding):
•
Take 400 mg of fluconazole by mouth. The next day take 200 mg of
fluconazole once each day for 14 days. But if you do not feel better in 3
to 5 days, increase the dose to 400 mg once each day. OR,
•
Take one 200 mg tablet of ketoconazole, by mouth, once a day with
food for 14 days.
Some people get relief from thrush
when they paint the inside of the
mouth with a little tea tree oil or yogurt.
tea tree
188 Where There Is No Dentist 2012
2. Sores of the skin of the mouth (ulcers)
Open sores (ulcers) that
can appear anywhere in
the mouth. Usually the skin
around the sores is red. The
sores in this picture are on the
inside of the top lip.
Most people from time to time have had a small open sore (ulcer) in the
mouth caused by an infection that has destroyed the skin in that area. It is
usually painful and can make eating and speaking difficult for 1 or 2 weeks.
The ulcer heals if the mouth is kept clean. For people with HIV infection,
the healing process can be very slow and sometimes the sore area in the
mouth becomes very large. This is especially true if the person is taking
anti-retroviral medicines to weaken HIV, such as zidovudine (AZT).
Signs:
The skin lining the mouth or on the tongue is broken and will probably look
much redder than the skin that is not broken.
Treatment:
Keep the area clean to control the infection and to help the skin heal. Clean
the sores with a cotton swab dipped in 1% povidone iodine. Or use any of the
methods described in the “General Treatment” box on pages 184 and 185.
Also give antibiotics if:
• the skin around the ulcer is very swollen, AND
•
you feel soft lumps (lymph glands) underneath the lower jaw bone.
Give 500 mg of amoxicillin by mouth, 3 times a day for 7 days. (Not safe
for people allergic to penicillin. Anyone who is allergic to penicillin will also
be allergic to amoxicillin and ampicillin).
OR 100 mg of doxycycline by mouth, 2 times a day for 7 days. (Not safe
for women who are pregnant or breastfeeding).
OR 500 mg of tetracycline by mouth, 4 times a day for 7 days. (Not safe
for women who are pregnant or breastfeeding).
OR 500 mg of erythromycin, 4 times a day for 7 days.
Where There Is No Dentist 2012 189
3. Infection of the gums
(Vincent’s Infection, trench mouth)
The skin around the teeth
(the gums) is painful, red and
puffy with oozing yellow
liquid (pus).
Many people have some infection of the gums around their teeth. The
amount of infection depends on how clean the mouth is kept and how
well a person’s body can fight off disease. If the mouth and gums are
not kept clean, the infection may get so bad that it will spread to the jaw
bone and other tissues nearby and the teeth will eventually loosen and
fall out.
Because the body of someone with HIV infection is less able to fight off
disease, any gum infection will quickly get worse if the person does not
keep his mouth and teeth clean. This can be very serious. If a person
with HIV loses his teeth and cannot eat, he will become even more ill.
Signs:
•
The gums are red, puffy, and very painful.
•
There may be yellow liquid (pus) oozing from the gum around one
or more teeth.
•
The gums between several teeth have sores (ulcers).
•
The person’s mouth smells very bad.
If the infection of the gums is very bad and advanced (as it can be for a
person with HIV), the signs may include:
•
red, raw ulcers of the gums.
•
the roots of the teeth will show.
•
pieces of the jaw bone can be seen at the bottom of the ulcers.
•
some teeth are loose.
190 Where There Is No Dentist 2012
Treatment:
•
Keep the area clean to control the infection
and to help the skin heal. Use any of
the methods described in the “General
Treatment” box on pages 184 and 185.
•
Very gently remove the tartar around the
teeth. Be especially careful not to cause
damage to the gums (see “Scaling Teeth”
on pages 127 to 133).
Also give antibiotics if:
• the neck is sore or stiff, and there are soft lumps just underneath the
lower jaw bone.
Give 500 mg of amoxicillin by mouth, 3 times a day for 7 days.
Women who are pregnant or breastfeeding can use this treatment.
OR for persons allergic to amoxicillin, give 100 mg of doxycycline by
mouth, 2 times a day for 7 days.
OR give 500 mg of tetracycline by mouth, 4 times a day for 7 days.
Do not give tetracycline to pregnant women because it can harm a
baby’s developing teeth.
OR for women who are pregnant or breastfeeding, and are allergic to
amoxicillin, give 500 mg of erythromycin by mouth, 4 times a day for
7 days.
•
the gums between the teeth have ulcers, and the person’s mouth
smells bad.
Give 500 mg of metronidazole by mouth, 2 times a day for 7 days.
Once the area is clean and the infection is controlled, take out any teeth that
are very loose (see pages 163 to 167).
Where There Is No Dentist 2012 191
More serious gum infection
(gangrene of the face, Noma, Cancrum Oris)
Signs:
In the most severe gum infection, the jaw bone will
become infected and this can spread through the cheek
to the face. This will be very easy to see, as parts of the
face and jaw rot away and smell bad. It happens mainly
to very sick children (usually one to four years old), but
can also happen to adults with HIV infection.
Treatment:
Get medical help as quickly as you can—in a hospital if possible.
In the meantime, use the information on pages 122 to 124 for cleaning and
treating the gangrene.
The medicines (antibiotics) listed on page 123 are for children. For an adult,
give the following:
For an adult who is able to swallow:
•
give 400 mg of
metronidazole by mouth,
3 times a day for 10 days,
if you cannot get
metronidazole give 450 mg of
clindamycin by mouth, 4 times a
day, for 5 days.
• OR
if clindamycin is not available give 500 mg of erythromycin
by mouth, 4 times a day, for 10 days.
• OR
Note: Clindamycin, erythromycin, and metronidazole are OK to use
for women who are pregnant or breastfeeding.
For an adult who cannot swallow:
•
inject 2,000,000 (2 million) Units of penicillin G into a large muscle,
3 times a day, for 7 days.
For an adult who is allergic to penicillin,
•
inject 600 mg of clindamycin into a large muscle, 4 times a day,
for 5 days.
If you give the medicines by injection, change to medicines by mouth
once the person starts to feel better. But do not stop giving the medicines
until the 7 to 10 days have passed.
192 Where There Is No Dentist 2012
4. Cold sores or fever blisters
Painful red blisters on
the gums that have burst
open and become small,
open sores.
Many people get cold sores or fever blisters caused by the herpes virus.
People who become infected with herpes carry the virus forever. Most
people are infected as children. The herpes sores can come and go. For
more information, see page 104.
The herpes sores usually heal after 1 or 2 weeks. But for persons
infected with HIV, the sores come more often and last much longer.
Signs:
1. One or more small, sometimes painful, red blisters appear on the
lips and skin around the mouth. In people with HIV infection, they
also appear just inside the lips, and on the gums and the roof of the
mouth.
2. The blisters burst and become small open sores that often spread
into each other.
3. After the blisters on the lips burst, a yellow crust
forms over them.
The herpes sores can pick up other infections,
particularly in people with HIV infection. Also, the
liquid inside the sores and blisters can spread
infection. If herpes is spread to the eyes, it can
cause blindness. Keep fingers and hands away
from sores because they contain very active
virus. It is very important to wash the hands
before and after touching the face or eyes.
Where There Is No Dentist 2012 193
Treatment:
Medicine cannot kill the herpes virus. Keep the area clean to control any
infection in the sores and to help them heal. Keep fingers and hands away
from the sores, and drink lots of fluids. Use any of the methods described
in the “General Treatment” box on pages 184 to 185.
Also:
•
Begin treatment as soon as you feel a
tingling, before the cold sore appears. This
may stop the sore from developing or
developing so severely.
•
A medicine called acyclovir may also help.
Give 200 mg by mouth, 5 times a day
for 7 to 10 days. You can also apply a
small amount of acyclovir ointment on
the sores 6 times a day for 7 days. It is
OK to use them both at the same time.
Acycolvir works best if taken or used early
in the infection, before the blisters burst, if
possible.
•
If the sores are infected, give 500 mg of amoxicillin, 3 times a day
for 7 days.
OR for persons allergic to amoxicillin, give 100 mg of doxycycline,
2 times a day for 7 days.
OR for a woman who is allergic to penicillin, and is pregnant or
breastfeeding, give 500 mg of erythromycin, 4 times a day for 7 days.
•
Antibacterial ointments such as neomycin or bacitracin can also help to
prevent and control other infections that get into the sores. Stop using
the acyclovir and spread a small amount of anti-bacterial ointment on
the infected skin outside the mouth (not in the mouth) 2 to 5 times a
day for about 5 days.
•
To help ease the pain of sores outside the mouth, stop using acyclovir
and cover the area with a dry powder, like baby powder, talc, or
cornstarch. Do not use medicated powders as they can make the open
sores sting very badly. Wash hands carefully before and after using
powder.
194 Where There Is No Dentist 2012
5. Red or purple patches in the mouth
(Kaposi’s sarcoma)
Painless, red-, brown-,
or purple-colored patches
(that look like swollen
bruises). They can appear
anywhere in the mouth.
The patches in this picture
are on the top (roof) of
the mouth.
Some people infected with HIV will get red- or purple-colored patches in
the mouth. These patches are called Kaposi’s sarcoma and they can also
appear elsewhere on the body. Kaposi’s sarcoma can be an early sign of
HIV infection.
Signs:
Painless patches that look like swollen bruises around or inside the
mouth. The red or purple color is more obvious in the mouth. The
patches rarely become infected and painful, usually only if they burst.
Treatment:
Get advice from a health worker
or doctor who is experienced
with the problems of HIV.
People who are taking antiretroviral medicines (ARVs) tend
not to get this kind of cancer.
And starting treatment with
ARVs can keep it from getting
worse. Sometimes very strong
anti-cancer medicines are used.
Also, some medicines for
treatment of varicose veins can
be helpful.
Where There Is No Dentist 2012 195
6. Dry or painful mouth and throat
Many people with AIDS have difficulty eating near the end of their lives
because of a dry or painful mouth and throat. But it is important to eat
nutritious food during a sickness, even a serious sickness like AIDS. The
person will feel much more comfortable and have less pain and infection
if he or she can eat well.
A dry mouth can be caused by an infected swelling in the glands of the
mouth that usually make spit (saliva). This is most common for people
taking ARVs (anti-retroviral medicines). A painful mouth can be caused
by other infections and problems that come with HIV and AIDS.
For information about how to treat an infection of the spit gland, see
page 119. For help with eating if the mouth is very dry or sore, try the
following:
•
Eat soft foods in small pieces that are easy to chew and swallow.
•
Cook foods until they are soft and tender.
•
Mix foods with liquids to make them easier to swallow.
•
Keep a small bottle of drinking water with you all the time.
•
Use a straw to drink fluids.
•
Do not eat hot or spicy foods. They can irritate
a sore mouth and throat.
•
If it is difficult to swallow, tilt the head back a
little, or move it forward.
•
Rinse the mouth with clean water often. This
will remove food and germs, and help with
healing.
196 Where There Is No Dentist 2012
Helping People with HIV
in Your Community
As a dental worker or health worker, you can make a great difference in the
well-being of both the person with HIV and his or her family. Take a special
interest in them and help them find ways to get the care and companionship
they need.
Care During the Final Days
During the final days of their illness, most people with AIDS prefer to be at
home with their families. Both the sick person and the family need a lot of
care and help during this time. This includes care for health problems and
personal needs, as well as help with social and legal issues.
You can support the family if you organize volunteers in the community to:
•
provide food and cook meals.
•
help with daily household chores.
•
look after babies and children whose parents are dying,
or who may have already died.
•
help with funeral arrangements.
It may also help to ask other family members, friends, or a religious leader to
visit the family and the person who is dying. This support can help the sick
person to die with dignity, and the family to cope with losing a loved one.
Where There Is No Dentist 2012 197
Working for Change In Your Community
By teaching and talking about HIV, dental workers can play an important role
in helping to stop the spread of the disease.
Treating people with HIV infection helps to prevent its spread.
You can help if you:
•
Learn as much as you can about HIV, how it is spread, and how to
prevent it.
•
Share your knowledge about HIV with others in community meeting
places—like schools, stores, religious meetings, restaurants and bars,
and military bases.
•
Teach people how to practice safer sex to stop the spread of HIV. Safer
sex is when no body fluids pass from one person to another during
sex.
•
Educate people about the importance of using clean needles for
injections. In hospitals and health centers, make sure your needles
come out of a sealed, sterile packet. Set up needle exchange programs
for IV drug users in your community.
Practice Safer Sex
Safer sex means to:
•
have sex with only one partner who has sex
only with you.
•
always use condoms during sex, and help
women learn how to ask men to use them.
•
think of other ways to have pleasure, such
as touching genitals with the hands, and
rubbing or massaging different parts of the
body.
•
not have sex with someone who shares
drug injection needles.
If the whole community has good information about HIV and safer sex, men
and women and their partners may feel more comfortable making changes
in their sex lives to protect themselves. No one has become infected with
HIV because he or she spoke openly and honestly about safer sex.
198 Where There Is No Dentist 2012
Although it can be difficult to speak openly about sex, to help prevent the
spread of HIV it is necessary to talk about what is risky sex and what is
safer sex.
How risky are different kinds of sex?
sex in the anus without a condom
sex in the vagina without a condom
sex with many people
sex when the vagina is dry
sex with someone who has had sex
with many people
sex without ejaculation
(“pulling out”)
sex using a diaphragm
sex with only one person who
only has sex with you
oral sex
(mouth on penis or vagina)
sex using a condom
kissing or touching
mutual masturbation
Treat Everyone with Respect
All people have a right to be respected, including people who have HIV. Set
an example in your community by supporting people with HIV, their partners,
and their families. Some people think AIDS is a “disease of outsiders“ or of
“bad” people. They think HIV does not affect “good” people like them. But
HIV affects rich and poor people, men and women, people of all races and
religions, health workers, and religious leaders.
Many people are afraid to take the HIV test or seek treatment because they
think they will be treated badly. We must all take care not to let our fear of
HIV and AIDS make us treat people unfairly. Anyone who is ill should be
cared for with kindness and respect.
Where There Is No Dentist 2012 199
As a health and dental worker, you and other
community and religious leaders can help people
with HIV get health services, housing and jobs.
You can help people treat each other with
respect, and you can encourage people who
have HIV to become involved in their treatment
and in their community’s activities.
Remember, you can help support the human rights of
people living with HIV or someone who people think
is living with HIV. Discriminating against them violates
HIV is not a curse or a
their human rights.
punishment.
Set an Example and Share Good Information
The example you set and the information you share will help fight the fear
people have of knowing, touching or living with someone who has HIV.
Make sure people know that HIV is not spread by ordinary daily contact. HIV
is not spread by hugging, touching, holding or shaking hands, by dancing,
using the toilet after someone with HIV, or eating food prepared by a person
with HIV. People can share dishes, towels, and bed sheets and not become
infected with HIV. Also, it is not possible to get infected from someone’s
tears, sneeze or spit, or from a mosquito bite.
Other viruses such as measles or chicken pox are spread easily through the
air. But HIV spreads only if certain body fluids of a person with HIV get inside
another person.
As a health worker, you can help people make decisions based on good
information and not fear. A good way to begin is to plan a meeting to discuss
HIV with other health workers in your area or region and with someone from
a regional HIV organization. He or she can help health workers learn about
HIV so they will be able to provide accurate, consistent information to the
people in their communities. They can also learn about the best ways to
treat the infections that people with HIV often get.
A person with HIV can get sick very easily
with many common health problems such as
pain, cough, skin rashes, fever and diarrhea.
For information about these problems,
see Where There Is No Doctor, or another
general medical book.
200 Where There Is No Dentist 2012
Follow your Own Advice
As a dental worker and health leader, you can have a great impact on your
community’s health and well-being if you set a good example. It is not
enough just to give health education talks and tell people how to behave. As
you talk to people about the importance of practicing safer sex, you must
remember to also practice safer sex with your own sexual partner. A dental
worker who does not practice safer sex can become infected with HIV and
pass the virus to others.
Here is an example of what can happen to dental workers if they do not
follow their own advice:
Two years ago, in one region of a country, there were 15
health centers that provided dental services. Today, 5 of the
centers can no longer provide these services because their
dental workers—all men—have died from AIDS. Also, 2 of the
15 students in a recent dental training course—a man and a
woman—have HIV. No one knows exactly how each one got
infected with HIV, but most people believe it was because
they were not careful with their sexual partners. The dental
workers and students gave many health education talks to tell
people how to behave, but people in the community could see
that they did not follow the advice themselves.
Where There Is No Dentist 2012 201
Think of Yourself as a Teacher
As a dental worker, you will be able to improve the health of the people in
your community and help prevent the spread of HIV if you think of yourself
as a teacher. The knowledge you share can have a more lasting impact on
the health and well-being of a community than your skills as a dental worker.
By making connections with people and organizations working on different
aspects of HIV, you will learn new information that can help you and your
community. Contact local, regional, and national groups who work on HIV
education and prevention, on providing service for people with HIV, and on
expanding access to ARVs and other medicines.
Help people with the
resources you have, and
think about where you
might find more resources
to help meet people’s
needs.
If all health workers can give the same correct, up-to-date information, it will
help prevent the fear caused by wrong ideas about AIDS. If their neighbors are
not afraid of them, people with HIV—as well as those who care for them­—
can become more accepted in the community. Then they can help others
understand every person’s real risk of getting HIV. So learn as much as you
can about HIV and share the information with everyone.
Remember to:
•
Give advice to the people you treat, especially those most at risk for
getting infected, such as young people, migrants and refugees, sex
workers, drug users who share needles, and anyone having sex with
more than one faithful partner.
•
Fight for improvements in the social and legal services available for
people with HIV. Remember, the fight is against the conditions that
lead to the spread of HIV, and not against people who have HIV.
Fight to end discrimination against those infected
with HIV. Discrimination is an obstacle to care. It
may stop people from coming for treatment and it
may stop people from learning how to prevent the
spread of infection.